Allergy Frontiers:Therapy and Prevention

Foreword

Preface

Contents

Contributors

Part I: Therapy and Prevention of Allergies

Chapter 1

Allergen Avoidance and Prevention of Allergy

Introduction

Definitions

Risk Factors

At Risk Population

Early Critical Period

Allergen Exposure

Exposure and Disease

Primary Prevention

Food Allergen Avoidance

Breast Feeding

During Pregnancy

Late Introduction of Solid Foods

Hydrolyzed Milk Formulae

Aeroallergens

House Dust Mite Allergen Avoidance

Other Aeroallergens

Combined Approach

Secondary Prevention

Occupational Allergens

Food Allergens

Aeroallergens

Summary

References

Chapter 2

Pharmacotherapy of Allergic Rhinitis

Introduction

Oral H1 -Antihistamines

First Generation H1 -Antihistamines

Second Generation H1 -Antihistamines

Cetirizine

Levocetirizine

Loratadine

Desloratadine

Fexofenadine

Intranasal H1 -Antihistamines

Azelastine

Olopatadine

Intranasal Corticosteroids

INS Compared with Placebo

Comparison of Individual INS

INS Compared with Oral H1 Antihistamines

Adverse Effects of INS

Leukotriene Modifying Agents

Local Chromones

Local Anticholinergics

Decongestants

Summary

References

Chapter 3

Antihistamines in Rhinitis and Asthma

Histamine: Role in Health and Disease

Histamine Receptors and Agonists: Diversity of Action

Classifications of Allergic Rhinitis and Implications for Treatment

Antihistamines in the Treatment of Allergic Rhinitis: Beyond the Histamine Effects

Antihistamines in Asthma: Same Airway Disease, but Dramatically Different

Antihistamines in Children, Elderly and Pregnant Women with Rhinitis

The Ideal Antihistamine: Basis for Comparison of all Existing Preparations

References

Chapter 4

Antiallergic and Vasoactive Drugs for Allergic Rhinitis

Introduction

Guidelines for the Treatment of AR

Cornerstones of Rhinitis Treatment

Oral H1 -Receptor Antagonists

Topical Nasal H1 -Receptor Antagonists

Topical Nasal Corticosteroids

Systemic Corticosteroids

Antileukotrienes

Sodium Cromoglicate

Anti-IgE

Intranasal Decongestants

Oral Decongestants

Conclusion

References

Chapter 5

Antileukotrienes in Asthma and Rhinitis

Introduction

The Leukotriene Biosynthetic Pathway

Cellular Sources of Leukotrienes

Cysteinyl-Leukotriene Receptors

Actions of cys-LTS in Asthma and Rhinitis

Bronchoconstriction

Vascular Effects

Leukocyte Recruitment

Other Inflammatory Actions

Airway Remodeling

Leukotrienes in Biological Fluids

Classes of Oral Antileukotriene Drug

Antileukotriene Drugs in Provocation Studies

Allergen Bronchoprovocation

Exercise and Cold Air Challenges

Aspirin Challenge

Efficacy of Antileukotriene Drugs in Asthma

Acute Asthma

Chronic Asthma

Anti-Inflammatory and Remodeling Effects

Comparison with Other Asthma Therapies

Add-on Therapy and Steroid-Tapering Trials

Efficacy of Antileukotriene Drugs in Allergic Rhinitis

Monotherapy

Combination Therapy

Safety, Compliance, and Adherence

Variability in Clinical Response

Summary

References

Chapter 6

Mechanisms of Action of beta2 Adrenoceptor Agonists

Introduction

Adrenoceptor Populations in the Airways

Molecular Genetics of the Human beta2 Adrenoceptor

Structure–Function Relationships of the beta2 Adrenoceptor

Distribution of beta2 Adrenoceptor Expression

Regulation of beta2 Adrenoceptor Expression

Pharmacology of beta Adrenoceptor Agonists

Clinical Pharmacology of SABAs and LABAs

Clinical Effects

Safety of SABAs and LABAs

Summary

References

Chapter 7

Alkylxanthines and Phosphodiesterase 4 Inhibitors for Allergic Diseases

Introduction

Generic Properties and Characteristics of Cyclic Nucleotide PDEs

Phosphodiesterase 4

Therapeutic Indications of PDE4 Inhibitors

Anti-inflammatory Effects of PDE Inhibitors In Vivo

IgE-Mediated Processes

Proinflammatory Cell Infiltration

Microvascular Leakage and Edema

Clinical Trials of Theophylline in Asthma

Clinical Trials of PDE4 Inhibitors in Asthma and Rhinitis

Asthma

Clinical Trials of PDE4 Inhibitors in Psoriasis and Atopic/Contact Dermatitis

Rolipram and Rolipram Analogues

Xanthines

Thalidomide Derivatives

Safety, Tolerability, Drug Metabolism and Pharmacokinetics of Theophylline and PDE4 Inhibitors: A Comparison

Adverse Events of Theophylline and PDE4 Inhibitors

Theophylline

PDE4 Inhibitors

Concluding Remarks

References

Chapter 8

Glucocorticoid Insensitive Asthma

Definition of GC Insensitive Asthma

Abnormal Activation of the GC Receptor and its Nuclear Inhibitory Effects

GC Insensitivity Due to the Presence of a “Different” Inflammatory Process

GC Insensitivity Due to the Lack of Any Inflammatory Process

GC Insensitivity Due to the Presence of an Inflammatory Process in a Region of the Lung Poorly Accessible to Inhaled CS Therapy

Approaches to Therapy in GC Insensitive Patients

Conclusions

References

Chapter 9

Recalcitrant Asthma

Introduction

Definitions of Severe Asthma

Risk Factors for Severe Asthma

Genetic Risk Factors

Environmental Risk Factors

Infections

Smoking

Obesity

Gastroesophageal Reflux Disease (GERD)

Adherence

Histological Features of Severe Asthma

Management of Severe Asthma

New Approaches to Treatment of Severe Asthma

Conclusion

References

Chapter 10

Mechanisms and Management of Exercise-Induced Bronchoconstriction

Introduction

Epidemiology

Pathogenesis

Clinical Manifestations

Diagnosis

Differential Diagnosis

Management

Pharmacological

Beta 2 Agonists

Cromoglycates

Inhaled Corticosteroids

Leukotriene-Modifying Agents

Histamine (H 1 ) Antagonists

Dietary Modification

Other Therapies

Nonpharmacological

Conclusion

References

Chapter 11

Use of Theophylline and Sodium Cromoglycate in Adult Asthma

Introduction

Properties of Sustained-Release Theophylline

Pharmacological Properties of Theophylline

Anti-Inflammatory Effects of Theophylline

Safety of Theophylline

Evidence Supporting the Effectiveness of Theophylline for the Long-Term Management of Asthma

Evidence Supporting the Concurrent Use of Theophylline and Inhaled Corticosteroids

Evidence Supporting the Effectiveness of Theophylline for Severe Asthma

References

Chapter 12

New Insights into Allergen-Specific Immunotherapy in Rhinitis and Asthma

Historical Context

Injection Immunotherapy

Efficacy and Safety

Mechanisms

Long-Lasting Effect and Prevention

Sublingual Immunotherapy

Efficacy and Safety

Mechanisms

Aspects Currently Under Investigation

Future Developments

Novel Formulations and Routes of Administration

Immunotherapy with Adjuvants

Immunotherapy with Bacterial Adjuvants

DNA-Adjuvanted Immunotherapy

Immunotherapy with Peptides

Recombinant and Engineered Allergens

Concluding Remarks

References

Chapter 13

Sublingual Immunotherapy in Allergic Rhinitis and Asthma

Introduction

Mechanisms

Clinical Evidence of Efficacy

New Dosing Regimes

Economic Evaluation

Safety

Psychological Stress and Response to SLIT

Future Directions

References

Chapter 14

Anti-IgE in Allergic Airway Diseases: Indications and Applications

Introduction: Role of IgE and Anti-IgE Molecules

Proof of Concept of Omalizumab Actions in Asthma

Clinical Efficacy in Allergic Asthma

Design of Studies

Asthma Exacerbations

Inhaled Corticosteroids

The Effect of Omalizumab on Other Medication Use, Including Beta-2 Agonists and Oral Corticosteroids

Lung Function

Quality of Life

Severe Asthma

Children

Predictors of Response to Omalizumab

Asthma Guidelines

Allergic Rhinitis

Mechanism of Action of Anti-IgE

Pharmacokinetics of Omalizumab

Safety of Omalizumab

Neoplasms

Immune Complex and Antibodies

Helminth Infection

Thrombocytopenia

Summary

References

Chapter 15

Drug Delivery Devices and Propellants

Introduction

Aerosol Characteristics

Aerosol Devices

Inhalers

Dry Powder Inhalers (DPI)

Pressurized Metered Dose Inhalers (pMDI)

Breath Activated pMDI

Venturi Type Jet Nebulizers (JN)

Breath Activated Nebulizers

Large Volume Nebulizers (LVN)

Ultrasonic Nebulization

Vibrating Mesh Nebulizers (VM)

Other New Nebulizer Technologies

Accessory Devices

Spacers

Valved Holding Chambers (VHC)

Masks

Activation Enablers

Special Uses

Neonatal and Pediatric Aerosol Therapy

Emergency Department Aerosol Delivery for Acute Asthma

Care of Devices

Jet Nebulizer Maintenance

VHC Maintenance

DPI and pMDI Maintenance

Patient Education

References

Chapter 16

Update on the Management of AtopicDermatitis/Eczema

Introduction

Basic Approach to Therapy

Avoidance of Exacerbating Factors

Topical Treatments

Emollients

Topical Steroids

Topical Calcineurin Inhibitors

Infection and Antimicrobial Treatments

Bacterial Infections

Viral Infections

Fungal Infections

Antimicrobial Peptides

Anti-Itch Treatment

Systemic Immunosuppressive Therapy

Systemic Steroids

Methotrexate

Oral Calcineurin Inhibitors

Mycophenolate Mofetil

Azathioprine

Biologics

Interferon- gamma (rIFN- gamma)

Intravenous Immunoglobulin (IVIg)

Tumor Necrosis Factor (TNF) alpha inhibitors (Etanercept – Enbrel®,Amgen; Infliximab – Remicade®, Centocor; Adalimumab –Humira®, Abbott)

Anti-LFA agents (Efalizumab – Raptiva®, Genentech-Xoma)

Anti IgE Agents (Omalizumab – Xolair®, Genentech)

Alternative Approaches

Probiotics

Gamma linoleic Acid (GLA)

Psychological Interventions

Conclusions

References

Chapter 17

Immunosuppressants as Treatment for Atopic Dermatitis

Introduction

Glucocorticosteroids

GCS Signaling

GCS and the Th1/Th2 Balance

GCS and Antigen Presentation

GCS and Leucocyte Migration

GSC and Cell Viability/Skin Barrier

GSC and Mast Cells/Eosinophils

Cyclosporine

CsA and Keratinocytes

CSA and Leukocyte Migration

CsA and IgE Autoreactivity

Calcineurine Inhibitors

CNI and T cells

CNI and Antigen Presentation

CNI and Eosinophils

CNI and Effector Cells

CNI and Keratinocytes

Mycophenolate Mofetil

Methotrexate

Intravenous Immunoglobulines

Biologicals

Conclusion

References

Chapter 18

Management of Anaphylaxis

The Prevention of Anaphylactic Episodes

General Preventive Measures

Preventive Measures for Patients at Risk

Management of the Acute Event

Treatment Administered in a Medical Facility

Immediate Measures

Measures Initiated After Further Evaluation

Treatment in the Field by the Patient

The Observation Period After Resolution of Symptoms

Fatalities

References

Chapter 19

Anaphylaxis: Are Regulatory T Cells the Targetof Venom Immunotherapy?

Abbreviations

Introduction

Types of TReg Cells and Allergic Responses to Insect Venoms

Role of T Reg Cells During Natural Tolerance and Venom SIT

Conclusion

References

Chapter 20

Food Allergy: Opportunities and Challenges in the Clinical Practice of Allergy and Immunology

Introduction

Allergen-Specific Immunotherapy

Allergen Immunotherapy

Subcutaneous Immunotherapy (SCIT)

Oral Immunotherapy (Specific Oral Tolerance Induction, SOTI)

Sublingual Immunotherapy (SLIT)

Modified Recombinant Vaccines

Peptide Immunotherapy

Immunostimulatory Sequence-Conjugated Protein Immunotherapy

Plasmid DNA Immunotherapy

Allergen Non-Specific Immunotherapy

Anti-IgE

Herbal Medicine

Summary and Conclusions

References

Chapter 21

Early Immunological Influences on Asthma Development: Opportunities for Early Intervention

Introduction

Postnatal Development of Immune Competence

Recent Thymic Emigrants (RTE) and the Conundrum of Intrauterine Sensitisation to Allergens

Immune Maturation and Genetic Risk for Atopic Disease

Pathways Leading to Development of Wheeze in Childhood: Towards a Rational Basis for Development of Effective Prevention Strategies

Strategies for Primary and Secondary Prevention of Persistent Atopic Asthma: Current and Future Options

Rational for Early Intervention Strategies for Asthma Prevention

Targeting Postnatal Maturation of Immune Competence

Protection against the Induction and Persistence of Allergic Sensitization

Early Treatment with Anti-Inflammatory Drugs to Blunt the Asthma-Promoting Effects of Airway Inflammation in Children

Protection Against Early Respiratory Viral Infections: The Ultimate Challenge

Conclusions

References

Chapter 22

Asthma and Allergy in Childhood: Predictionand Early Diagnosis

Why Should We Predict Disease?

Some Definitions and Considerations

Prediction Versus Risk Factors

Tools for Prediction

Early Diagnosis

References

Chapter 23

Early Interventions in Allergic Diseases

Introduction

Risk Factors for Allergies and Asthma

Respiratory Viruses, Wheezing, Allergen Sensitization and Asthma

Breast Feeding

Endotoxin

Pet Ownership

Tobacco Smoke

Therapeutic and Preventive Strategies

Perspectives of Treatment and Prevention of Respiratory Viral Infections

Environmental Interventions in Genetically Predisposed Infants

Pharmacological Treatment

Allergen-Specific Immunotherapy

Conclusions

References

Chapter 24

Birth Cohort Studies for the Prevention of Allergy: New Perspectives—Where Do We Go from Now?

Introduction

Study Design

Cross-Sectional Studies

Cohort Studies

Observational Birth Cohort Studies

Interventional Birth Cohort Studies

Defining Allergies

Natural Course of Allergic Illnesses

Risk Factors and Protective Exposures

Nutrition

Maternal Diet

Breastfeeding

Hypoallergenic Infant Formula

Infantile Diet

Probiotics

Environmental Factors

Environmental Tobacco Smoke

Traffic Related Pollution

Inhaled Allergens

Pets

Family Size/Day Care

Infections

Microbial Exposures in the Environment

Antibiotics/Vaccinations/Paracetamol

Multifaceted Interventional Studies

Secondary and Tertiary Prevention in Cohort Studies

Conclusion

Where do we go from now?

References

Chapter 25

Novel Immunomodulatory Strategies for the Prevention of Atopy and Asthma

Introduction

The Need for Early Interventions for Allergy Prevention

Limitations of Current Strategies

Identifying Target Populations for PreventionStrategies - the Need for Better Allergy Predictors

Novel Non-Invasive Strategies Using Dietary Nutrients to Prevent Disease

Novel Strategies using other Microbial Products

The Role of Allergen Immunotherapy

Future Directions

References

Chapter 26

Recombinant Allergens for Therapy and Prevention: Molecular Design and Delivery of Allergy Vaccines

Introduction

Recombinant Allergens

Recombinant Allergy Vaccines

Molecular Design of Allergy Vaccines

Delivery of Allergy Vaccines

Cytokines

CpG DNA

Live Bacillus Calmette-Guerin BCG

Live Vectors

Nanoparticles

Future of Immunotherapy

Concluding Remarks

References

Chapter 27

Prevention of Allergic Diseases

Introduction

Factors in the Environment that May Confer Protection

Farm Milk Consumption

Raw Vegetable and Fresh Fruit Consumption

Natural Water Consumption

Tolerance

Definition of Tolerance

Mechanisms Involved in the Development of Tolerance

Bell-Shaped Curve

Toll-Like Receptors in the Development of Tolerance

Healthy Immune Response vs. Allergic Immune Response

Can Tolerance Be Restored in Atopic Individuals?

Primary Prevention

The Finnish Allergy Programme 2008–2018 Launched

Goals and Focus

Conclusion

References

Chapter 28

Emerging Nonsteroidal Anti-Inflammatory Therapies Targeting Specific Mechanisms in Asthma and Allergy

Introduction

Anti-Leukotrienes

Anti-Prostanoids

Nonsteroidal Therapy in Asthma & Allergy 467act also as a CRTH2 receptor antagonist. Modest, though beneficial effects havebeen reported when applied in allergic rhinitis and asthma, the drug has been registeredin Japan as a controller of allergy [18]. Pres

Anti-IgE

Allergen Specific Immunotherapy

Anti-Cytokine Therapy

Anti-TNF- alpha

Anti-IL-5

Anti-IL-4 and Anti-IL-13

Anti-IL-13

Anti-IL-9

IL-10

Recombinant IL-12

Conclusion Anti-Cytokine Therapy

Probiotics

Heparins

Other Potential Anti-Asthma Targets

Conclusion

References

Part II: Special Consideration in Children, Elderly and Pregnancy

Chapter 29

Asthma and Rhinitis in Pregnancy

Introduction

Asthma During Pregnancy

Asthma Control

Asthma Exacerbations

Lung Function During Pregnancy

Rhinitis During Pregnancy

Allergic Rhinitis

Pregnancy Rhinitis

Snoring and Rhinitis in Pregnancy

Maternal and Fetal Complications of Asthma in Pregnancy

Low Birth Weight

Preterm Birth

Pre-eclampsia and Pregnancy induced hypertension

Congenital Malformations

Perinatal Mortality

Management of Asthma and Rhinitis During Pregnancy

Managing Asthma and Rhinitis

Treatment of Asthma Exacerbations During Pregnancy

Safety of Drug Treatments for Asthma and Rhinitis

beta2 -Agonists

Inhaled Corticosteroids

Intranasal Corticosteroids

Oral Corticosteroids

Leukotriene Receptor Antagonists

Antihistamines

Nasal Decongestants

Conclusions

References

Chapter 30

Asthma in the Elderly

Introduction

Diagnosis

Onset and Prevalence

Course

Death

Management and Treatment

Irreversibility

Summary and Conclusions

References

Chapter 31

The Natural History of Childhood Asthma

Introduction

Definition of Asthma

When does Asthma begin?

Who gets Asthma?

Natural History of Early Childhood Asthma

Can the Natural History of Asthma be Altered?

Other Asthma Phenotypes in Childhood

Summary

References

Chapter 32

The Wheezing Infant and Young Child

Interpretation of Wheeze

Infant Wheeze

Early Wheezing and Prematurity

Wheezing after RSV Bronchiolitis

Recurrent Symptoms Beyond Infancy

Atopic Asthma

Viral Associated Wheeze

Cough

Major Environmental Factors

Airway Inflammation and Remodelling

Persistence and Resolution

Implications for Therapy

Conclusions

References

Chapter 33

Acute Severe Asthma in Children

Definition

Epidemiology of Severe Acute Asthma in Children

Recognition and Treatment of Severe Acute Asthma

Assessment in the Emergency Department or Acute Care Facility

First Line Care in the ED

The History and Physical Examination

Ongoing ED Care

Monitoring Response to Therapy

Consideration of Hospital Based Therapy

Respiratory Failure

Prevention and Discharge Planning

Summary

References

Chapter 34

Best Estimates of Asthma Control in Children

Asthma Severity Versus Asthma Control

Assessment of Asthma Control Using Subjective Measures

Symptom Assessments

Quality of Life Measures

Healthcare Utilization

Assessment of Asthma Control Using Objective Measures

Monitoring the Peak Expiratory Flow Rate

Forced Expiratory Spirometry

Sputum Eosinophil Counts

Measurement of Exhaled Nitric Oxide

Is Asthma Control Possible?

Achieving Asthma Control

Improving Asthma Control

References

Chapter 35

Risk-Benefit of Asthma Therapy in Children: Topical Corticosteroids

Characteristics of Inhaled Corticosteroids

Effects of Inhaled Corticosteroids

Similarities and Differences in Inhaled Corticosteroids

Benefits of Inhaled Corticosteroids in Children

Overview of Efficacy of Inhaled Corticosteroids

Early Intervention with Inhaled Corticosteroids

Failure to Respond to Inhaled Corticosteroids

Risks of Inhaled Corticosteroids in Children

Effect of ICS on Linear Growth and Bone Metabolism

Effect of ICS on the HPA Axis

Other Potential Adverse Effects of ICS

Maximizing the Benefits and Minimizing the Risks

Inhaled Corticosteroids in Infants

Combining Inhaled Corticosteroids with Long-Acting Beta-Agonists in Children

Conclusion: Treatment with ICS in Asthmatic Children: Risk or Benefit?

References

Chapter 36

Risk-Benefit of Asthma Therapy in Children: Nonsteroidal Anti-Inflammatory Drugs

Introduction

General Principles

Cromolyn Sodium and Nedocromil

Mechanism of Action

Benefits and Place in Therapy

Risks and Drawbacks

Ketotifen

Mechanism of Action

Benefits and Place in Therapy

Risks and Drawbacks

Theophylline

Mechanism of Action

Benefits and Place in Therapy

Risks and Drawbacks

Leukotriene Modifiers

Mechanism of Action

Benefits and Place in Therapy

Risks and Drawbacks

Omalizumab

Mechanism of Action

Benefits and Place in Therapy

Risks and Drawbacks

Conclusions

References

Chapter 37

The Role of Influenza Vaccination in Asthmatic Children

Introduction

Influenza: Incidence and Clinical Impact

Availability and Immunogenicity of Vaccines

Adverse Effects of Influenza Vaccination

Effectiveness

Vaccine Uptake in Children with Asthma

Cost Effectiveness of Influenza Vaccination

Conclusion

References

Chapter 38

Treatment of Infants with Atopic Dermatitis

Genetic and Other Risk Factors for AD

Pathophysiology

Triggers of AD

Allergens

Microorganisms

Irritant Factors

Diagnostic Work-Up

Food

Treatment

Basic Treatment

Topical Treatment

Emollients

Topical Glucocorticosteroids

Topical Calcineurin Inhibitors (TCIs)

Wet-Wrap Therapy

Topical Antimicrobial Therapy

Systemic Treatment

Antimicrobial Treatment

Systemic Corticosteroids

Cyclosporin A

Antihistamines

Diet

Education

References

Chapter 39

Diagnosing Food Allergy in Children

Introduction

Features of IgE-Mediated Food Allergy

Features of NonIgE-Mediated Food Allergy

Evaluation of the Food Allergic Child

History

Physical Examination

Skin Testing

Atopy Patch Testing

Laboratory Testing

Elimination Diets

Food Challenges

Management of the Food Allergic Child

Future Directions

References

Chapter 40

Diagnosis and Treatment of Latex Allergy

Introduction

Latex Allergens

Functional Properties of Latex Allergens

Biological Properties

Polyisoprene Elongation

Plant Defense Functions

Common Enzymes and Structural Proteins

Immunologic Properties

Immune Responses to Rubber Biosynthesis Proteins

Immune Responses to Defense-Related proteins

Hev b 8 (Profilin)

Hev b 9 (Enolase)

Hev b 10 (Manganese Superoxide Dismutase )

Hev b 11 (Endochitinase)

Hev b 12 (Lipid Transfer Protein)

Hev b 13 (Latex Esterase)

Diagnosis of Latex Allergy

In Vitro Testing for Latex Allergy

In Vivo Provocation Testing

Prevention and Treatment of the Patient with Latex Allergy

Summary

References

Chapter 41

New Aspects of Peanut and Tree Nut Allergy

Introduction

Environmental and Genetic Factors

Genetics

Linkage Analyses

HLA

SPINK5

Peanut and Tree Nut Allergens

Peanut

Hazelnut

Walnut

Almond, Cashew and Brazil Nut

Cross-Reactivity

Tree Nut Allergy

Diagnosis

Skin Testing

IgE Levels

Possibilities for Remission

Avoidance

Treatments

Immunotherapy

Anti-IgE

Herbal Treatments

Conclusions

References

Chapter 42

Allergic Fungal Sinusitis: Controversy and Evolution of Understanding with Therapeutic Implications

Introduction

Historical Aspects

Confusion and Controversy over the Diagnosis of AFS Categorization

Epidemiology and Geography

Pathophysiology Similarities and Differences of AFS to ABPFD

Proteases and Fungal Sinus Disease

Superantigen and Genetic Predisposition

IgE Levels and Associated Fungal Findings

Fungal Culture

Clinical Presentation

Radiological Findings

Treatment

Surgical Management

Medical Management

Antifungal Therapy

Immunotherapy

Anti-IgE

Other Modalities

Discussion

References

Chapter 43

Immunomodulatory Role of Bacillus Calmette-Guérin in the Prevention and Therapy of Allergy and Asthma

Abbreviations

Introduction

Hygiene Hypothesis

Bacillus Calmette-Guérin

Therapeutic Effects of BCG

BCG in Allergy and Asthma

Factors Regulating Efficacy of BCG as an Anti-Asthma Therapy

BCG-Induced Immunoregulation and Airway Remodeling

T H 1/T H 2 Concept

Growing Skepticism on the T H 1/T H 2 Concept

Role of Other Immunoregulatory Cells

T reg Cells

CD8 + T-Cells

gamma delta -T Cells

NKT Cells

Antigen Presenting Cells

Role of NRAMP and TLRs

NRAMP1

Toll-Like Receptors

Conclusion

References

Chapter 44

Use of Theophylline and Sodium Cromoglycate in Pediatric Asthma

Introduction

Theophylline

Pharmacological Properties

Physiological Effects

Anti-Inflammatory Effects

Molecular Mechanisms of Theophylline Effects

PDE Inhibition

Adenosine Receptor Antagonism

Other Effects

Therapeutic Use

Epigenetics

Sodium Cromoglycate

Introduction

Pharmacological Properties

Pharmacologic Effects

Absorption, Fate and Excretion

Toxicity

Therapeutic Use

References

Chapter 45

Antibody Deficiency Syndromes (Including Diagnosis and Treatment)

Introduction

Antibody-Mediated Immunity

Clinical Aspects of Antibody Deficiency

General Evaluation of Antibody-Mediated Immunity

Antibody Deficiency Syndromes

Agammaglobulinemia

Hyper-IgM Syndrome

Common Variable Immunodeficiency Disease (CVID)

Transient Hypogammaglobulinemia of Infancy

Selective IgA Deficiency

IgG Subclass Deficiencies

IgG1 Subclass Deficiency

IgG2 Subclass Deficiency

IgG3 Subclass Deficiency

IgG4 Subclass Deficiency

Specific Antibody Deficiency with Normal Immunoglobulins

Selective Anti-Pure (Non-Conjugated) Polysaccharide Antibody Deficiency

Treatment of Antibody Deficiencies

Clinical Staging of Complications

Summary

References

Index